Laparoscopic repair of large diaphragmatic hernia after left ventricular assist device implantation followed by orthotopic heart transplantation

Abstract

In patients with advanced heart failure and deteriorating clinical status, a left ventricular assist device (LVAD) can be used as a bridge to transplantation or as an alternative to transplantation. An uncommon complication of orthotopic heart transplant or LVADs is diaphragmatic hernia during implantation or explantation of the device. We describe a patient with a diaphragmatic hernia with incarcerated colon and small bowel treated previously with a HeartMate 3 LVAD and subsequent transplantation. This case highlights the need to consider the diagnosis of diaphragmatic hernia based on symptoms after HeartMate 3 implantation and/or subsequent transplantation, as well as the ability to manage these hernias with a minimally invasive laparoscopic approach to minimize postoperative morbidity and mortality.

Keywords:

• Diaphragmatic hernia
• laparoscopic repair
• left ventricular assist device
• orthotopic heart transplantation

DECLARATION OF INTEREST

Dr. Steven Leeds is a consultant for Ethicon and Boston Scientific. Dr. Marc Ward is a consultant for Boston Scientific. All other authors have no conflicts of interest to disclose.